Development of New Morbidities in Children Undergoing Cardiac Surgery

Introduction: One in twelve children admitted to pediatric ICUs will develop new morbidity by time of discharge. However, little is known about the risk factors for development of new morbidities in cardiac surgery patients. In this project, we aimed to better understand risk factors associated with the development of new morbidities in pediatric cardiac surgery patients.


Methods: We included data from the Virtual Pediatric Systems database for children who underwent cardiac surgery between 4/2017 and 12/2023. Functional status was measured using the Functional Status Score (FSS) at admission and discharge from the ICU. Patients were risk stratified based off the complexity of surgical repair, with scores ranging from 1 (least complex) to 5 (most complex). We defined a composite post-surgical complication outcome variable comprising mechanical ventilation, renal replacement therapy, ECMO, CPR, arrhythmia, stroke, and/or unplanned re-operation.


Results: 1447 patients from 24 United States PICUs were included. 45% were female and 62% were < 2 years old (Table 1). Baseline FFS at admission was 6, representing good function. 60% had a surgical complexity score of either 1 or 2. 14% developed a new morbidity. This increased across surgical complexity scores (5.1% in least complex to 42.7% in most complex). 976 patients (67%) had at least one complication. In multivariate analysis controlling for patient age, length of stay, and surgical complexity, occurrence of a post-operative complication was associated with increased odds of developing a new morbidity (aOR 6.2 [2.6-14.9], p< 0.01).


Conclusions: Children undergoing cardiac surgery are at higher risk for new morbidity compared to the general PICU population. Patients with major post-surgical complications were at elevated risk for development of new morbidities and represents a targeted population that may benefit from closer monitoring, or early intervention to mitigate the development of new morbidities.